|
HC LAAC IMPLANT
|
Facility
|
OP
|
$18,942.56
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,339.57 |
| Max. Negotiated Rate |
$17,048.30 |
| Rate for Payer: Aetna Commercial |
$16,101.18
|
| Rate for Payer: Aetna Medicare |
$4,925.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,919.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,919.55
|
| Rate for Payer: BCBS Complete |
$3,506.27
|
| Rate for Payer: BCBS MAPPO |
$4,735.64
|
| Rate for Payer: BCBS Trust/PPO |
$15,572.68
|
| Rate for Payer: BCN Commercial |
$15,572.68
|
| Rate for Payer: BCN Medicare Advantage |
$4,735.64
|
| Rate for Payer: Cash Price |
$15,154.05
|
| Rate for Payer: Cofinity Commercial |
$16,290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,154.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,735.64
|
| Rate for Payer: Healthscope Commercial |
$17,048.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,206.92
|
| Rate for Payer: Mclaren Medicaid |
$3,339.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,972.42
|
| Rate for Payer: Meridian Medicaid |
$3,506.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,445.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,209.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,101.18
|
| Rate for Payer: Nomi Health Commercial |
$15,532.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,206.92
|
| Rate for Payer: PACE Senior Care Partners |
$4,498.86
|
| Rate for Payer: PACE SWMI |
$4,735.64
|
| Rate for Payer: PHP Commercial |
$16,101.18
|
| Rate for Payer: PHP Medicare Advantage |
$4,735.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,339.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,480.03
|
| Rate for Payer: Priority Health Medicare |
$4,783.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,184.02
|
| Rate for Payer: Railroad Medicare Medicare |
$4,735.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,669.45
|
| Rate for Payer: UHC Core |
$15,817.04
|
| Rate for Payer: UHC Exchange |
$4,735.64
|
| Rate for Payer: UHC Medicaid |
$3,339.57
|
| Rate for Payer: UHC Medicare Advantage |
$4,735.64
|
| Rate for Payer: UHCCP Medicaid |
$3,339.57
|
| Rate for Payer: VA VA |
$4,735.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,206.92
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,561.63
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,086.89 |
| Max. Negotiated Rate |
$1,405.47 |
| Rate for Payer: Aetna Commercial |
$1,327.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,289.75
|
| Rate for Payer: BCN Commercial |
$1,289.75
|
| Rate for Payer: Cash Price |
$1,249.30
|
| Rate for Payer: Cofinity Commercial |
$1,343.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.30
|
| Rate for Payer: Healthscope Commercial |
$1,405.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,171.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.39
|
| Rate for Payer: Nomi Health Commercial |
$1,280.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.22
|
| Rate for Payer: PHP Commercial |
$1,327.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,358.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,086.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,374.23
|
| Rate for Payer: UHC Core |
$1,303.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,171.22
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,561.63
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$275.32 |
| Max. Negotiated Rate |
$1,405.47 |
| Rate for Payer: Aetna Commercial |
$1,327.39
|
| Rate for Payer: Aetna Medicare |
$406.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.01
|
| Rate for Payer: BCBS Complete |
$289.06
|
| Rate for Payer: BCBS MAPPO |
$390.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.82
|
| Rate for Payer: BCN Commercial |
$1,283.82
|
| Rate for Payer: BCN Medicare Advantage |
$390.41
|
| Rate for Payer: Cash Price |
$1,249.30
|
| Rate for Payer: Cofinity Commercial |
$1,343.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.41
|
| Rate for Payer: Healthscope Commercial |
$1,405.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,171.22
|
| Rate for Payer: Mclaren Medicaid |
$275.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.93
|
| Rate for Payer: Meridian Medicaid |
$289.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.39
|
| Rate for Payer: Nomi Health Commercial |
$1,280.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.22
|
| Rate for Payer: PACE Senior Care Partners |
$370.89
|
| Rate for Payer: PACE SWMI |
$390.41
|
| Rate for Payer: PHP Commercial |
$1,327.39
|
| Rate for Payer: PHP Medicare Advantage |
$390.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,358.62
|
| Rate for Payer: Priority Health Medicare |
$394.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,086.89
|
| Rate for Payer: Railroad Medicare Medicare |
$390.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,374.23
|
| Rate for Payer: UHC Core |
$1,303.96
|
| Rate for Payer: UHC Exchange |
$390.41
|
| Rate for Payer: UHC Medicaid |
$275.32
|
| Rate for Payer: UHC Medicare Advantage |
$390.41
|
| Rate for Payer: UHCCP Medicaid |
$275.32
|
| Rate for Payer: VA VA |
$390.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,171.22
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,082.24
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,449.24 |
| Max. Negotiated Rate |
$1,874.02 |
| Rate for Payer: Aetna Commercial |
$1,769.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.72
|
| Rate for Payer: BCN Commercial |
$1,719.72
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Commercial |
$1,790.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Healthscope Commercial |
$1,874.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,561.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Nomi Health Commercial |
$1,707.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: PHP Commercial |
$1,769.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,811.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,449.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.37
|
| Rate for Payer: UHC Core |
$1,738.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,561.68
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,082.24
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$367.10 |
| Max. Negotiated Rate |
$1,874.02 |
| Rate for Payer: Aetna Commercial |
$1,769.90
|
| Rate for Payer: Aetna Medicare |
$541.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$650.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$650.70
|
| Rate for Payer: BCBS Complete |
$385.42
|
| Rate for Payer: BCBS MAPPO |
$520.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.81
|
| Rate for Payer: BCN Commercial |
$1,711.81
|
| Rate for Payer: BCN Medicare Advantage |
$520.56
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Commercial |
$1,790.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.56
|
| Rate for Payer: Healthscope Commercial |
$1,874.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,561.68
|
| Rate for Payer: Mclaren Medicaid |
$367.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.59
|
| Rate for Payer: Meridian Medicaid |
$385.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$598.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Nomi Health Commercial |
$1,707.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: PACE Senior Care Partners |
$494.53
|
| Rate for Payer: PACE SWMI |
$520.56
|
| Rate for Payer: PHP Commercial |
$1,769.90
|
| Rate for Payer: PHP Medicare Advantage |
$520.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,811.55
|
| Rate for Payer: Priority Health Medicare |
$525.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,449.24
|
| Rate for Payer: Railroad Medicare Medicare |
$520.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.37
|
| Rate for Payer: UHC Core |
$1,738.67
|
| Rate for Payer: UHC Exchange |
$520.56
|
| Rate for Payer: UHC Medicaid |
$367.10
|
| Rate for Payer: UHC Medicare Advantage |
$520.56
|
| Rate for Payer: UHCCP Medicaid |
$367.10
|
| Rate for Payer: VA VA |
$520.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,561.68
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,602.68
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,811.47 |
| Max. Negotiated Rate |
$2,342.41 |
| Rate for Payer: Aetna Commercial |
$2,212.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.55
|
| Rate for Payer: BCN Commercial |
$2,149.55
|
| Rate for Payer: Cash Price |
$2,082.14
|
| Rate for Payer: Cofinity Commercial |
$2,238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,082.14
|
| Rate for Payer: Healthscope Commercial |
$2,342.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,952.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.28
|
| Rate for Payer: Nomi Health Commercial |
$2,134.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.01
|
| Rate for Payer: PHP Commercial |
$2,212.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,264.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,811.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,290.36
|
| Rate for Payer: UHC Core |
$2,173.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,952.01
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,602.68
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$458.85 |
| Max. Negotiated Rate |
$2,342.41 |
| Rate for Payer: Aetna Commercial |
$2,212.28
|
| Rate for Payer: Aetna Medicare |
$676.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.34
|
| Rate for Payer: BCBS Complete |
$481.76
|
| Rate for Payer: BCBS MAPPO |
$650.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,139.66
|
| Rate for Payer: BCN Commercial |
$2,139.66
|
| Rate for Payer: BCN Medicare Advantage |
$650.67
|
| Rate for Payer: Cash Price |
$2,082.14
|
| Rate for Payer: Cofinity Commercial |
$2,238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,082.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.67
|
| Rate for Payer: Healthscope Commercial |
$2,342.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,952.01
|
| Rate for Payer: Mclaren Medicaid |
$458.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.20
|
| Rate for Payer: Meridian Medicaid |
$481.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$715.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.28
|
| Rate for Payer: Nomi Health Commercial |
$2,134.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.01
|
| Rate for Payer: PACE Senior Care Partners |
$618.14
|
| Rate for Payer: PACE SWMI |
$650.67
|
| Rate for Payer: PHP Commercial |
$2,212.28
|
| Rate for Payer: PHP Medicare Advantage |
$650.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,264.33
|
| Rate for Payer: Priority Health Medicare |
$657.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,811.47
|
| Rate for Payer: Railroad Medicare Medicare |
$650.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,290.36
|
| Rate for Payer: UHC Core |
$2,173.24
|
| Rate for Payer: UHC Exchange |
$650.67
|
| Rate for Payer: UHC Medicaid |
$458.85
|
| Rate for Payer: UHC Medicare Advantage |
$650.67
|
| Rate for Payer: UHCCP Medicaid |
$458.85
|
| Rate for Payer: VA VA |
$650.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,952.01
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,123.27
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,173.80 |
| Max. Negotiated Rate |
$2,810.94 |
| Rate for Payer: Aetna Commercial |
$2,654.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,579.51
|
| Rate for Payer: BCN Commercial |
$2,579.51
|
| Rate for Payer: Cash Price |
$2,498.62
|
| Rate for Payer: Cofinity Commercial |
$2,686.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,498.62
|
| Rate for Payer: Healthscope Commercial |
$2,810.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,342.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,654.78
|
| Rate for Payer: Nomi Health Commercial |
$2,561.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,342.45
|
| Rate for Payer: PHP Commercial |
$2,654.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,717.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,173.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,748.48
|
| Rate for Payer: UHC Core |
$2,607.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,342.45
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
OP
|
$3,123.27
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$550.63 |
| Max. Negotiated Rate |
$2,810.94 |
| Rate for Payer: Aetna Commercial |
$2,654.78
|
| Rate for Payer: Aetna Medicare |
$812.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.02
|
| Rate for Payer: BCBS Complete |
$578.12
|
| Rate for Payer: BCBS MAPPO |
$780.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,567.64
|
| Rate for Payer: BCN Commercial |
$2,567.64
|
| Rate for Payer: BCN Medicare Advantage |
$780.82
|
| Rate for Payer: Cash Price |
$2,498.62
|
| Rate for Payer: Cofinity Commercial |
$2,686.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,498.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.82
|
| Rate for Payer: Healthscope Commercial |
$2,810.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,342.45
|
| Rate for Payer: Mclaren Medicaid |
$550.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.86
|
| Rate for Payer: Meridian Medicaid |
$578.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$897.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$858.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,654.78
|
| Rate for Payer: Nomi Health Commercial |
$2,561.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,342.45
|
| Rate for Payer: PACE Senior Care Partners |
$741.78
|
| Rate for Payer: PACE SWMI |
$780.82
|
| Rate for Payer: PHP Commercial |
$2,654.78
|
| Rate for Payer: PHP Medicare Advantage |
$780.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$550.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,717.24
|
| Rate for Payer: Priority Health Medicare |
$788.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,173.80
|
| Rate for Payer: Railroad Medicare Medicare |
$780.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,748.48
|
| Rate for Payer: UHC Core |
$2,607.93
|
| Rate for Payer: UHC Exchange |
$780.82
|
| Rate for Payer: UHC Medicaid |
$550.63
|
| Rate for Payer: UHC Medicare Advantage |
$780.82
|
| Rate for Payer: UHCCP Medicaid |
$550.63
|
| Rate for Payer: VA VA |
$780.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,342.45
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
OP
|
$4,681.34
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$825.32 |
| Max. Negotiated Rate |
$4,213.21 |
| Rate for Payer: Aetna Commercial |
$3,979.14
|
| Rate for Payer: Aetna Medicare |
$1,217.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,462.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,462.92
|
| Rate for Payer: BCBS Complete |
$866.52
|
| Rate for Payer: BCBS MAPPO |
$1,170.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,848.53
|
| Rate for Payer: BCN Commercial |
$3,848.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,170.34
|
| Rate for Payer: Cash Price |
$3,745.07
|
| Rate for Payer: Cofinity Commercial |
$4,025.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,170.34
|
| Rate for Payer: Healthscope Commercial |
$4,213.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,511.01
|
| Rate for Payer: Mclaren Medicaid |
$825.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,228.85
|
| Rate for Payer: Meridian Medicaid |
$866.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,345.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,287.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.14
|
| Rate for Payer: Nomi Health Commercial |
$3,838.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.01
|
| Rate for Payer: PACE Senior Care Partners |
$1,111.82
|
| Rate for Payer: PACE SWMI |
$1,170.34
|
| Rate for Payer: PHP Commercial |
$3,979.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,170.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,072.77
|
| Rate for Payer: Priority Health Medicare |
$1,182.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,258.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,170.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,119.58
|
| Rate for Payer: UHC Core |
$3,908.92
|
| Rate for Payer: UHC Exchange |
$1,170.34
|
| Rate for Payer: UHC Medicaid |
$825.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,170.34
|
| Rate for Payer: UHCCP Medicaid |
$825.32
|
| Rate for Payer: VA VA |
$1,170.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,511.01
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
IP
|
$4,681.34
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,258.21 |
| Max. Negotiated Rate |
$4,213.21 |
| Rate for Payer: Aetna Commercial |
$3,979.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,866.32
|
| Rate for Payer: BCN Commercial |
$3,866.32
|
| Rate for Payer: Cash Price |
$3,745.07
|
| Rate for Payer: Cofinity Commercial |
$4,025.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.07
|
| Rate for Payer: Healthscope Commercial |
$4,213.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,511.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.14
|
| Rate for Payer: Nomi Health Commercial |
$3,838.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.01
|
| Rate for Payer: PHP Commercial |
$3,979.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,072.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,258.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,119.58
|
| Rate for Payer: UHC Core |
$3,908.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,511.01
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
IP
|
$6,925.85
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,820.39 |
| Max. Negotiated Rate |
$6,233.27 |
| Rate for Payer: Aetna Commercial |
$5,886.97
|
| Rate for Payer: BCBS Trust/PPO |
$5,720.06
|
| Rate for Payer: BCN Commercial |
$5,720.06
|
| Rate for Payer: Cash Price |
$5,540.68
|
| Rate for Payer: Cofinity Commercial |
$5,956.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,540.68
|
| Rate for Payer: Healthscope Commercial |
$6,233.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,194.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,886.97
|
| Rate for Payer: Nomi Health Commercial |
$5,679.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,194.39
|
| Rate for Payer: PHP Commercial |
$5,886.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,025.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,820.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,094.75
|
| Rate for Payer: UHC Core |
$5,783.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,194.39
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
OP
|
$6,925.85
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,221.03 |
| Max. Negotiated Rate |
$6,233.27 |
| Rate for Payer: Aetna Commercial |
$5,886.97
|
| Rate for Payer: Aetna Medicare |
$1,800.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,164.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,164.33
|
| Rate for Payer: BCBS Complete |
$1,281.97
|
| Rate for Payer: BCBS MAPPO |
$1,731.46
|
| Rate for Payer: BCBS Trust/PPO |
$5,693.74
|
| Rate for Payer: BCN Commercial |
$5,693.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,731.46
|
| Rate for Payer: Cash Price |
$5,540.68
|
| Rate for Payer: Cofinity Commercial |
$5,956.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,540.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,731.46
|
| Rate for Payer: Healthscope Commercial |
$6,233.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,194.39
|
| Rate for Payer: Mclaren Medicaid |
$1,221.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,818.04
|
| Rate for Payer: Meridian Medicaid |
$1,281.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,991.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,904.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,886.97
|
| Rate for Payer: Nomi Health Commercial |
$5,679.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,194.39
|
| Rate for Payer: PACE Senior Care Partners |
$1,644.89
|
| Rate for Payer: PACE SWMI |
$1,731.46
|
| Rate for Payer: PHP Commercial |
$5,886.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,731.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,221.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,025.49
|
| Rate for Payer: Priority Health Medicare |
$1,748.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,820.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,731.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,094.75
|
| Rate for Payer: UHC Core |
$5,783.08
|
| Rate for Payer: UHC Exchange |
$1,731.46
|
| Rate for Payer: UHC Medicaid |
$1,221.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,731.46
|
| Rate for Payer: UHCCP Medicaid |
$1,221.03
|
| Rate for Payer: VA VA |
$1,731.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,194.39
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
IP
|
$4,096.05
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,850.85 |
| Max. Negotiated Rate |
$3,686.45 |
| Rate for Payer: Aetna Commercial |
$3,481.64
|
| Rate for Payer: Aetna Commercial |
$5,222.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,382.93
|
| Rate for Payer: BCBS Trust/PPO |
$5,074.40
|
| Rate for Payer: BCN Commercial |
$3,382.93
|
| Rate for Payer: BCN Commercial |
$5,074.40
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cofinity Commercial |
$5,283.91
|
| Rate for Payer: Cofinity Commercial |
$3,522.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,915.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.84
|
| Rate for Payer: Healthscope Commercial |
$3,686.45
|
| Rate for Payer: Healthscope Commercial |
$5,529.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,072.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,608.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,481.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,222.47
|
| Rate for Payer: Nomi Health Commercial |
$3,358.76
|
| Rate for Payer: Nomi Health Commercial |
$5,038.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,072.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,608.06
|
| Rate for Payer: PHP Commercial |
$5,222.47
|
| Rate for Payer: PHP Commercial |
$3,481.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,345.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,563.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,850.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,604.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,406.79
|
| Rate for Payer: UHC Core |
$3,420.20
|
| Rate for Payer: UHC Core |
$5,130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,072.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,608.06
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
OP
|
$4,096.05
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.13 |
| Max. Negotiated Rate |
$3,686.45 |
| Rate for Payer: Aetna Commercial |
$3,481.64
|
| Rate for Payer: Aetna Commercial |
$5,222.47
|
| Rate for Payer: Aetna Medicare |
$1,597.46
|
| Rate for Payer: Aetna Medicare |
$1,064.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,920.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,280.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,280.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,920.03
|
| Rate for Payer: BCBS Complete |
$758.18
|
| Rate for Payer: BCBS Complete |
$1,137.27
|
| Rate for Payer: BCBS MAPPO |
$1,024.01
|
| Rate for Payer: BCBS MAPPO |
$1,536.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,367.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,051.05
|
| Rate for Payer: BCN Commercial |
$5,051.05
|
| Rate for Payer: BCN Commercial |
$3,367.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,536.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,024.01
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cofinity Commercial |
$3,522.60
|
| Rate for Payer: Cofinity Commercial |
$5,283.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,915.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,536.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,024.01
|
| Rate for Payer: Healthscope Commercial |
$3,686.45
|
| Rate for Payer: Healthscope Commercial |
$5,529.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,072.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,608.06
|
| Rate for Payer: Mclaren Medicaid |
$1,083.20
|
| Rate for Payer: Mclaren Medicaid |
$722.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,612.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,075.21
|
| Rate for Payer: Meridian Medicaid |
$758.18
|
| Rate for Payer: Meridian Medicaid |
$1,137.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,766.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,177.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,689.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,126.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,222.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,481.64
|
| Rate for Payer: Nomi Health Commercial |
$5,038.15
|
| Rate for Payer: Nomi Health Commercial |
$3,358.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,072.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,608.06
|
| Rate for Payer: PACE Senior Care Partners |
$1,459.22
|
| Rate for Payer: PACE Senior Care Partners |
$972.81
|
| Rate for Payer: PACE SWMI |
$1,536.02
|
| Rate for Payer: PACE SWMI |
$1,024.01
|
| Rate for Payer: PHP Commercial |
$3,481.64
|
| Rate for Payer: PHP Commercial |
$5,222.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,024.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,536.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,083.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$722.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,345.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,563.56
|
| Rate for Payer: Priority Health Medicare |
$1,551.38
|
| Rate for Payer: Priority Health Medicare |
$1,034.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,850.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,276.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,024.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,536.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,604.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,406.79
|
| Rate for Payer: UHC Core |
$5,130.31
|
| Rate for Payer: UHC Core |
$3,420.20
|
| Rate for Payer: UHC Exchange |
$1,536.02
|
| Rate for Payer: UHC Exchange |
$1,024.01
|
| Rate for Payer: UHC Medicaid |
$1,083.20
|
| Rate for Payer: UHC Medicaid |
$722.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,024.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,536.02
|
| Rate for Payer: UHCCP Medicaid |
$722.13
|
| Rate for Payer: UHCCP Medicaid |
$1,083.20
|
| Rate for Payer: VA VA |
$1,024.01
|
| Rate for Payer: VA VA |
$1,536.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,608.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,072.04
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
OP
|
$1,587.03
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$279.79 |
| Max. Negotiated Rate |
$1,428.33 |
| Rate for Payer: Aetna Commercial |
$1,348.98
|
| Rate for Payer: Aetna Medicare |
$412.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$495.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$495.95
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS MAPPO |
$396.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.70
|
| Rate for Payer: BCN Commercial |
$1,304.70
|
| Rate for Payer: BCN Medicare Advantage |
$396.76
|
| Rate for Payer: Cash Price |
$1,269.62
|
| Rate for Payer: Cofinity Commercial |
$1,364.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.76
|
| Rate for Payer: Healthscope Commercial |
$1,428.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,190.27
|
| Rate for Payer: Mclaren Medicaid |
$279.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.60
|
| Rate for Payer: Meridian Medicaid |
$293.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$436.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,348.98
|
| Rate for Payer: Nomi Health Commercial |
$1,301.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,190.27
|
| Rate for Payer: PACE Senior Care Partners |
$376.92
|
| Rate for Payer: PACE SWMI |
$396.76
|
| Rate for Payer: PHP Commercial |
$1,348.98
|
| Rate for Payer: PHP Medicare Advantage |
$396.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,380.72
|
| Rate for Payer: Priority Health Medicare |
$400.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.57
|
| Rate for Payer: Railroad Medicare Medicare |
$396.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,396.59
|
| Rate for Payer: UHC Core |
$1,325.17
|
| Rate for Payer: UHC Exchange |
$396.76
|
| Rate for Payer: UHC Medicaid |
$279.79
|
| Rate for Payer: UHC Medicare Advantage |
$396.76
|
| Rate for Payer: UHCCP Medicaid |
$279.79
|
| Rate for Payer: VA VA |
$396.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,190.27
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
IP
|
$1,587.03
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,104.57 |
| Max. Negotiated Rate |
$1,428.33 |
| Rate for Payer: Aetna Commercial |
$1,348.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,310.73
|
| Rate for Payer: BCN Commercial |
$1,310.73
|
| Rate for Payer: Cash Price |
$1,269.62
|
| Rate for Payer: Cofinity Commercial |
$1,364.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.62
|
| Rate for Payer: Healthscope Commercial |
$1,428.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,190.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,348.98
|
| Rate for Payer: Nomi Health Commercial |
$1,301.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,190.27
|
| Rate for Payer: PHP Commercial |
$1,348.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,380.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,396.59
|
| Rate for Payer: UHC Core |
$1,325.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,190.27
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$22.64
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cofinity Commercial |
$19.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: Nomi Health Commercial |
$18.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.98
|
| Rate for Payer: PHP Commercial |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.92
|
| Rate for Payer: UHC Core |
$18.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.98
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$22.64
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.08
|
| Rate for Payer: BCBS Complete |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$5.66
|
| Rate for Payer: BCBS Trust/PPO |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Medicare Advantage |
$5.66
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cofinity Commercial |
$19.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.66
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.98
|
| Rate for Payer: Mclaren Medicaid |
$3.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.94
|
| Rate for Payer: Meridian Medicaid |
$4.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: Nomi Health Commercial |
$18.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.98
|
| Rate for Payer: PACE Senior Care Partners |
$5.38
|
| Rate for Payer: PACE SWMI |
$5.66
|
| Rate for Payer: PHP Commercial |
$19.24
|
| Rate for Payer: PHP Medicare Advantage |
$5.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.70
|
| Rate for Payer: Priority Health Medicare |
$5.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.92
|
| Rate for Payer: UHC Core |
$18.90
|
| Rate for Payer: UHC Exchange |
$5.66
|
| Rate for Payer: UHC Medicaid |
$3.99
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: UHCCP Medicaid |
$3.99
|
| Rate for Payer: VA VA |
$5.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.98
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
IP
|
$60.49
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$54.44 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$49.96
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.39
|
| Rate for Payer: Healthscope Commercial |
$54.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.42
|
| Rate for Payer: Nomi Health Commercial |
$49.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.37
|
| Rate for Payer: PHP Commercial |
$51.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.23
|
| Rate for Payer: UHC Core |
$50.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.37
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
OP
|
$60.49
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$54.44 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Aetna Medicare |
$15.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.90
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$15.12
|
| Rate for Payer: BCBS Trust/PPO |
$49.73
|
| Rate for Payer: BCN Commercial |
$49.73
|
| Rate for Payer: BCN Medicare Advantage |
$15.12
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$54.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.37
|
| Rate for Payer: Mclaren Medicaid |
$10.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.88
|
| Rate for Payer: Meridian Medicaid |
$11.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.42
|
| Rate for Payer: Nomi Health Commercial |
$49.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.37
|
| Rate for Payer: PACE Senior Care Partners |
$14.37
|
| Rate for Payer: PACE SWMI |
$15.12
|
| Rate for Payer: PHP Commercial |
$51.42
|
| Rate for Payer: PHP Medicare Advantage |
$15.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.63
|
| Rate for Payer: Priority Health Medicare |
$15.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.10
|
| Rate for Payer: Railroad Medicare Medicare |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.23
|
| Rate for Payer: UHC Core |
$50.51
|
| Rate for Payer: UHC Exchange |
$15.12
|
| Rate for Payer: UHC Medicaid |
$10.66
|
| Rate for Payer: UHC Medicare Advantage |
$15.12
|
| Rate for Payer: UHCCP Medicaid |
$10.66
|
| Rate for Payer: VA VA |
$15.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.37
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
IP
|
$95.93
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.77 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$81.54
|
| Rate for Payer: BCBS Trust/PPO |
$79.23
|
| Rate for Payer: BCN Commercial |
$79.23
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.74
|
| Rate for Payer: Healthscope Commercial |
$86.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.54
|
| Rate for Payer: Nomi Health Commercial |
$78.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.95
|
| Rate for Payer: PHP Commercial |
$81.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.42
|
| Rate for Payer: UHC Core |
$80.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.95
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
OP
|
$95.93
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$81.54
|
| Rate for Payer: Aetna Medicare |
$24.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.98
|
| Rate for Payer: BCBS Complete |
$17.76
|
| Rate for Payer: BCBS MAPPO |
$23.98
|
| Rate for Payer: BCBS Trust/PPO |
$78.86
|
| Rate for Payer: BCN Commercial |
$78.86
|
| Rate for Payer: BCN Medicare Advantage |
$23.98
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$86.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.95
|
| Rate for Payer: Mclaren Medicaid |
$16.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.18
|
| Rate for Payer: Meridian Medicaid |
$17.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.54
|
| Rate for Payer: Nomi Health Commercial |
$78.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.95
|
| Rate for Payer: PACE Senior Care Partners |
$22.78
|
| Rate for Payer: PACE SWMI |
$23.98
|
| Rate for Payer: PHP Commercial |
$81.54
|
| Rate for Payer: PHP Medicare Advantage |
$23.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.46
|
| Rate for Payer: Priority Health Medicare |
$24.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.42
|
| Rate for Payer: UHC Core |
$80.10
|
| Rate for Payer: UHC Exchange |
$23.98
|
| Rate for Payer: UHC Medicaid |
$16.91
|
| Rate for Payer: UHC Medicare Advantage |
$23.98
|
| Rate for Payer: UHCCP Medicaid |
$16.91
|
| Rate for Payer: VA VA |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.95
|
|
|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCN Commercial |
$65.22
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.49
|
| Rate for Payer: UHC Core |
$65.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.23
|
|
|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.68
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$19.74
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: BCN Medicare Advantage |
$19.74
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.23
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.73
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Senior Care Partners |
$18.76
|
| Rate for Payer: PACE SWMI |
$19.74
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Medicare Advantage |
$19.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Medicare |
$19.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.49
|
| Rate for Payer: UHC Core |
$65.94
|
| Rate for Payer: UHC Exchange |
$19.74
|
| Rate for Payer: UHC Medicaid |
$13.92
|
| Rate for Payer: UHC Medicare Advantage |
$19.74
|
| Rate for Payer: UHCCP Medicaid |
$13.92
|
| Rate for Payer: VA VA |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.23
|
|
